For the successful operation of the middle ear with chronic otitis media preservation' or reconstruction of both the basic anatomical bony structure and of the ossicular chain are deemed necessary. In cases with cholesteatoma the bony lateral wall is often defective. Reconstruction of this b ony wall using cartilage plates should be accomplished in order to prevent the postoperative complication, retraction cholesteatoma. In cases where only the stapes is intact, continuity between the stapes and the tympanic graf t can be obtained by interpositioning one or more plates of cartilage between them. These plates of cartilage are very useful because they are more stable than a single strut. In cases where super structure of the stapes is missing improvement of hearing by surgery can only be expected by a 2-stage operation. Surgery to the middle ear often involves surgical insult to the ossicles as well as the tympanic membrane, therefore, it is most important to perform the surgery to these fine structures, talking into careful consideration their postoperative distortion. The underlay grafting seems to be a better procedure than overlay grafting in prevention of such postoperative distortions.
Salivary gland tumors occuring in aberrant locations are relatively rare. It is generally accepted that the aberrant salivary gland tumors are more malignant than those in the major glands, yet, many recent papers continue to describe simple enucleation as the treatment of choice. The authors describe a case of mixed tumor occurring in the hard palate of a female of 29 years. The tumor that had benign histological features initially, was subjected to repeated recurrence and repeated operations during a period of 14 years and finally became malignant. The tumors invaded the large part of the maxillary bone and a total maxillectomy was performed. The authors stress that the removal of the tumor together with an adequate margin of the normal soft and bony tissues should be performed at the initial operation for this type of tumor.
Causes of hoarseness among children can be found in other than organic changes of the vocal cords. They include various functional changes of the vocal cords that manifest various types of insufficient approximation of the two cords. The authors classified these functional causes of hoarseness by the appearance of the glottic space at phonation as follows: 1. I-letter Type 2. Triangular Type 3. Posterior Triangular Type 4. Uneven Closure Type 5. Wrinkled Closure Type 6. Oblique Type The authors suggested that these failures in closure may be caused by improper ways of phonation and a specific voice therapy would help these patients.
A case of tuberculosis of the thyroid gland occurring in a 67-year-old female is reported. Her initial findings included paralysis of the recurrent nerve, a tumor in the subglottic space and a small swelling in the neck. A biopsy of the cervical swelling revealed tuberculosis of the thyroid gland histopathologically. The patient has been treated successfully with streptomycin, INAH and PAS. The authors reviewed the domestic literature for this comparatively rare disease.
The epithelial cyst is a late complication of tympanic grafting in tympanoplasty. If left untreated this complication may cause a loss of the neotympanic membrane as in the case with cholesteatoma which is another serious late complication associated with tympanic grafting. The authors studied 190 cases of tympanoplasty with temporalis fascia grafts and showed that: 1. The overall incidence of epithelial cyst in the 190 cases has been 6.3% with a greater incidence in revision cases 9.6% as compared to 5.6% for initial operation cases. 2. No significant difference in the incidence of epithelial cyst has been noted between the two grafting methods, underlay and overlay methods. 3. The times between the operation and development of the epithelial cyst have ranged from 2 months to 13 months with an average period of 6.2 months. 4. The epithelial cyst has been found to be more frequently seen at the posterior aspect of the tympanic membrane. This fact may reflect a high frequency of surgical insult to the posterior aspect of the tympanic membrane and the posterior wall of the external auditory meatus. 5. The epithelial cyst of the tympanic membrane can be readily removed under magnification in ambulatory patients if found early in its stage.
There seems to be an increasing incidence for otolaryngologists to be consulted for treatment of otolaryngological involvements with leukemia because of recent prolonged remission in these patients as a result of various effective chemotherapy. The authors encountered 4 cases of acute leukemia during the past year and describe manifestations and complications involving ear, nose and throat together with otolaryngological care of these patients.